Goodwin Insights July 15, 2021

Class Certification Defeated in Litigation Alleging Excessive Prescription Drug Copayments

Key Takeaway: The defendant successfully argued that class certification of a proposed class implicating thousands of health plans was not viable due to differences in those plans’ governing language.

On May 20, 2021, the District of Connecticut denied a motion to certify a class in a case in which the plaintiffs alleged that the defendant, Cigna Health and Life Insurance Company, overcharged participants in health plans for their prescriptions. The plaintiffs alleged that certain health plans administered or insured by Cigna required pharmacies to charge an excessive amount in co-pays for prescription drugs. The plaintiffs claimed that the health plans then “clawed back” some portions of the excessive co-pays by requiring that pharmacies send funds back to Cigna, rather than to plan participants. The plaintiffs sought to certify a class consisting of individual plan participants in health plans insured or administered by Cigna.

The court denied the motion to certify a class because it found that the proposed class consisted of participants in thousands of health plans, and that those plans’ governing documents had different methodologies for calculating co-payments. The court concluded that interpreting the terms of so many different health plans would require significant individualized determinations, rendering the claims unsuitable for class-wide resolution. In so ruling, the court rejected the plaintiffs’ argument that a class could be certified because many of the plans shared the same language. The court explained that not all of the plans impacted by the prospective class used the same language and that the variations in language from plan to plan were potentially material. This decision is one of several recent ERISA decisions in which plaintiffs have been unable to certify a class consisting of participants in different benefits plans. The litigation remains pending and the plaintiffs are now seeking to file an amended motion for class certification with a narrowed class definition.

The case is Negron v. Cigna Health and Life Ins. Co., No. 16-cv-01702, in the District of Connecticut. The decision is available here.